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Cancer: A World Unto Itself

In his review “The Emperor of All Maladies: A Biography of Cancer,” by the oncologist Siddhartha Mukherjee, Steven Shapin writes:

[Mukherjee] sees that cancer is a world unto itself; that [his patient] is now part of this world; and that he is part of it, too. For cancer patients and their physicians, the cancer world seems to expand to the whole of experience. As one victim of a muscle sarcoma told Mukherjee, “I am in the hospital even when I am outside the hospital.”

In 2001, Alice Stewart Trillin wrote an account of the difficult decision she faced when her doctors were unable to come to a consensus about whether the symptoms she experienced in 1990—fluid in the lungs; back pain—were indicators of a recurrence of the cancer she had first suffered fourteen years before. Trillin recalls her thoughts as her doctor inserted a needle into her back to extract some fluid:

I started to think about what I would do if a presumably innocent cough turned out to be the sound of the other shoe dropping. I had once had good reason to listen for that other shoe; I’d had malignant lymph nodes in my mediastinum—the middle of my chest—as well as a tumor in my lung. I had always been amazed at how little time I’d spent listening for it, and what I most disliked about having the needle stuck into my back was that it began to awaken what I’d come to think of as the dragon that sleeps inside anyone who has had cancer. I’d written once that we can never kill this dragon, but we go about the business of our daily lives—giving our children breakfast, putting more mulch on our gardens—in the hope that it will stay asleep for a while longer. What I hadn’t said was what I’d do if the dragon woke up.

For Marjorie Gross, the dragon—in the form of ovarian cancer—did wake up. In her 1996 Personal History, “Cancer Becomes Me,” Gross gave readers a humorous take on her illness and the effects of the chemotherapy she underwent to treat it. Here she lists the “good things” about cancer treatment:

(1) You automatically get called courageous. The rest of you people have to save somebody from drowning. We just have to wake up.

(2) You are never called rude again. You can cancel appointments left and right, leave boring dinners after ten minutes, and still not become a social pariah.

(3) Everyone returns your calls immediately—having cancer is like being Mike Ovitz. And you’re definitely not put on hold for long.

(4) People don’t ask you to help them move.

(5) If you’re really shameless, you never have to wait in line for anything again. Take off the hat and get whisked to the front.

Earlier this year, Atul Gawande wrote about lung-cancer patient Sara Thomas Monopoli in “Letting Go,” his article on the treatment of the terminally ill. Monopoli was diagnosed with lung cancer when she was pregnant with her first child. After delivering her daughter, it was discovered that Monopoli had developed thyroid cancer. As she was scheduled to begin a course of experimental treatment, a CT scan revealed that the cancer had spread to Monopoli’s brain. Gawande described the reaction to this latest round of bad news.

And still Sara, her family, and her medical team remained in battle mode. Within twenty-four hours, Sara was scheduled to see a radiation oncologist for whole-brain radiation to try to reduce the metastases. On February 12th, she completed five days of radiation treatment, which left her immeasurably fatigued, barely able get out of bed. She ate almost nothing. She weighed twenty-five pounds less than she had in the fall. She confessed to Rich that, for the past two months, she had experienced double vision and was unable to feel her hands.

“Why didn’t you tell anyone?” he asked her.

“I just didn’t want to stop treatment,” she said. “They would make me stop.”

She was given two weeks to recover her strength after the radiation. Then she would be put on another experimental drug from a small biotech company. She was scheduled to start on February 25th. Her chances were rapidly dwindling. But who was to say they were zero?

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